Dyssynchrony Assessment with Tissue Doppler Imaging and Regional Volumetric Analysis by 3D Echocardiography Do Not Predict Long-Term Response to Cardiac Resynchronization Therapy

Abstract

Background. Currently there are no reliable predictors of response to cardiac resynchronization therapy (CRT) before implantation. We compared pre-CRT left ventricular (LV) dyssynchrony by tissue Doppler imaging (TDI) and regional volumetric analysis by 3-dimensional transthoracic echocardiography (3DTTE) in predicting response to CRT. Methods. Thirty-eight patients (79% nonischemic cardiomyopathy) with symptomatic heart failure who underwent CRT were enrolled. Clinical and echocardiographic responses were defined as improvement in one NYHA class and reduction in LV end-systolic volume by ≥15% respectively. Functional status was assessed by Minnesota Living with Heart Failure questionnaire and 6-minute walk distance. Results. In 33 patients, after CRT for 7.86 ± 2.27 months, there were 24 (73%) clinical and 19 (58%) echocardiographic responders. Functional parameters, LV dimensions, volumes and synchrony by TDI and 3DTTE improved significantly in responders. There was no difference in the number of responders and nonresponders when cut-off values for dyssynchrony by different measurements validated in other trials were applied. Area under receiver-operating-characteristic curve ranged from 0.4 to 0.6. Conclusion. CRT improves clinical and echocardiographic parameters in patients with systolic heart failure. The dyssynchrony measurements by TDI and 3DTTE are not comparable and are unable to predict response to CRT.

A Pilot Study of Systolic Dyssynchrony Index by Real Time Three‐Dimensional Echocardiography and Doppler Tissue Imaging Parameters Predicting the Hemodynamic Response to Biventricular Pacing in the Early Postoperative Period after Cardiac Surgery

“…A recently published study by Kuppahally et al 39 showed that dyssynchrony assessment using DTI and regional volumetric analysis by 3D echocardiography did not predict long‐term response to CRT. The possible explanation for the difference observed in the results between this study and our study may be the following.…”

How to treat cardiac dyssynchrony in heart failure with reduced ejection fraction

“…However, despite all efforts, prospective randomized, multicenter trials-such as the PROSPECT trial-failed to provide any reliable single echocardiographic parameter for dyssynchrony measurement that might improve patient selection for CRT beyond current guidelines. [17,18] Furthermore, the ECHO-CRT trial has shown that resynchronization therapy based solely on the presence of mechanical dyssynchrony (echocardiographic evidence of LV dyssynchrony) in NYHA III/IV HFrEF patients without electrical conduction disease (narrow QRS < 130 ms), did not improve outcome and was even associated with harm. [19] Cardiac magnetic resonance (CMR) has emerged during the last decade as the gold standard imaging technique for myocardial substrate assessment.…”